Originally published on KevinMD
All of us nurses and physicians in the ED and ICU knew him well.
He was a young, 21-year-old. A smart, articulate guy who kept going from one hospital to the next. He had a system down … almost.
This young man was a drug seeker. He knew all about seizures and how an Ativan IV push felt during the “seizures” he allegedly was having.
Even though he had several identities and different names, we knew exactly who he was. He would wait for an ICU nurse to assess him at the beginning of the shift.
After the nurse assessed this seemingly charming man, she’d exit his room but wouldn’t get too far from the door when she’d hear shaking from “Randy’s” bed. When she’d turn around, she’d see Randy in a full grand mal seizure. A chaotic quiver, clenched teeth, followed by rigid body and blank stare.
Damn. He was good!
His physicians were fooled for quite some time. They’d give him the EEG, the CT scan, and then the Ativan IV push … and the old standbys Dilantin and phenobarb, too. But “Randy” preferred the combo of Ativan and attention the most.
Eventually, he was diagnosed with “pseudoseizures,” which are not the same as a seizure. There are only two types of seizures: epileptic and nonepileptic.
We knew him well.
Epileptic seizures occur when a sudden electrical disturbance in the nerve cells in the brain causes the person to lose control of their body.
Psychogenic nonepileptic seizures (PNES), are seizures that occur as a result of psychological causes such as severe mental stress.
Pseudoseizures may be caused by: anxiety, OCD, panic attack’s, ADHD, traumatic injuries, ongoing family conflict, substance abuse, PTSD or physical or sexual abuse.
How do we treat of pseudoseizures?
Cognitive-behavioral therapy (CBT).
There was a conference: Randy and the intensivist. The doctor explained to Randy that his seizures were not from a neurological disorder. But the seizures he had developed were after multiple or acute stressors that overwhelmed his coping ability.
Randy was angry. Though he had many stressors in life, homelessness, non-compliant with his antidepressant medications, no-shows with therapy, Randy refused to listen to the doctor.
And so he continued aimlessly jumping from one hospital to the next — a new name for each hospital. No family. No home. An aimless wanderer.
Police found a young man in a fetal position at a bus stop. A tourniquet wrapped tightly around his arm. An empty syringe in his hand. Heroin.
Dead.
And with a pocketful of IDs:
Randy, Scott, Jeremy, Michael, Tim, Ryan.
We knew him well.
Do Not Resuscitate 